Controlled Substance Policies

At River of Hope, our goal is to ensure top quality care as well as patient safety. River of Hope has stringent controlled policy for patient safety. River of Hope realizes that these medications are necessary at times but strives to only prescribe these medications when medically appropriate. River of Hope is not required to take over prescribing a controlled substance from any outside prescribers. We do not prescribe multiple controlled substances at the same time including but not limited to: two different benzodiazepines, two different stimulants medications, a combination of benzodiazepine and stimulant, and a combination of buprenorphine and a benzodiazepine. 

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If River of Hope agrees to prescribe a patient a controlled substance, the patient will be required to annually sign a controlled substance agreement. This agreement outlines expectations between patient and prescriber while being prescribed a controlled substances. Examples of expectations include patient presenting in person for appointments, patient agreeing to random urine drug screens, patient refraining from use of illicit substances including marijuana, no early fills, and to get a refill patient must be in person for their appointment. If the patient does not adhere to the controlled substance agreement, their controlled substance may be discontinued. There are additional agreements required for each specific class of controlled substances. 

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Buprenorphine is a synthetic opioid medication that acts as a partial agonist at opioid receptors, but does not produce the euphoria and sedation caused by heroin or other opioids. Buprenorphine is able to reduce or eliminate withdrawal symptoms associated with opioid dependence and carries a low risk of overdose. If buprenorphine is prescribed, River of Hope policy is that the patient will come into the office for weekly check ins to make sure that the dosage is appropriate and that the patient is not experiencing any side effects. Due to the controlled nature of suboxone, at the longest, at least monthly visits are required. River of Hope's policy for buprenorphine treatment is that urine drug screens are performed at every visit.  

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For patients that desire treatment of a mental health condition with stimulant medications, River of Hope requires either a childhood diagnosis of attention deficit hyperactivity disorder (ADHD) or diagnosed by full neuropsychological evaluation to start stimulant medication for ADHD. If these cannot be completed, River of Hope is delighted to work with you utilizing non stimulant medications for attention and concentration such as Strattera and Wellbutrin. River of Hope only prescribes one stimulant medication, Vyvanse (lisdexamfetamine dimesylate). River of Hope does not prescribe other stimulant medications such as Ritalin, Adderall, and Focalin. All stimulant medications are contradicted in certain patient populations with examples including patients with a history of psychosis, eating disorders, or stimulant use disorder. 

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River of Hope follows guidelines and literature citing risk of tolerance, dependance, and addiction. River of Hope seeks to prescribe benzodiazepines for short term use as needed only.  River of Hope does not frequently start patients on benzodiazepines. If a patient is currently prescribed benzodiazepines, River of Hope will only continue prescribing if the patient agrees to goal of eventually tapering off of benzodiazepines and agree to taper plan at initial visit. Example taper plan will include decreasing dosage of benzodiazepines once monthly over the course of  several months and eventual cessation of benzodiazepine but may include up to #10 tablets of low dose benzodiazepine monthly for as needed use. Due to life threatening risks associated with benzodiazepine withdrawal, River of Hope does not taper patient's over a certain amount of benzodiazepines and may recommend inpatient detox. River of Hope follows guidelines for benzodiazepine use including that benzodiazepines are contraindicated with many different medications as well as with many psychiatric conditions.